Provider Demographics
NPI:1104621226
Name:BILEY, THOMAS JAMES
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:BILEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W SUPERIOR ST BLDG SUITE601
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1803
Mailing Address - Country:US
Mailing Address - Phone:218-522-4469
Mailing Address - Fax:218-520-3038
Practice Address - Street 1:306 W SUPERIOR ST BLDG SUITE601
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1803
Practice Address - Country:US
Practice Address - Phone:218-522-4469
Practice Address - Fax:218-520-3038
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4837101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health